Unexplained stroke: Look for Lyme disease

On rare occasions, Lyme neuroborreliosis (LNB) can cause a stroke. The authors of “Ischemic stroke: Do Not Forget Lyme Neuroborreliosis,” review the case of an 83-year-old man who was admitted to the emergency room of Geneva University Hospitals in Switzerland. [1] The case highlights the importance of gathering a complete patient history and in performing adequate ancillary tests.

“We here describe the case of an 83-year-old man for whom we strongly suspect Lyme neuroborreliosis as the etiology of his stroke,” writes Moreno Legast and colleagues in the journal Hindawi Case Reports in Neurological Medicine. [1]

The patient was admitted to the emergency room complaining of right-sided weakness and speech difficulties, which had developed over a 24-hour period.

Lyme neuroborreliosis causes a stroke, leaving an elderly man with partial paralysis of his right arm.

Multiple test images revealed a recent ischemic lesion in the left corona radiate, as well as a small left parietal lesion. There was no evidence of hypertension, large vessel disease, or a cardiac source. Instead, the workup revealed a positive lupus anticoagulant in a patient who did not have a history of venous or arterial thrombosis or autoimmune disease.

Because of the presence of a lupus anticoagulant antibody, the authors tested for infectious and autoimmune causes. According to Moreno Legast, antiphospholipid antibodies are associated with different infectious diseases. And, she adds, antiphospholipid antibodies have been reported in chronic Lyme disease.

Infectious and immune screenings were negative. But the ELISA and Western blot for Lyme disease came back positive.

Clinicians then reassessed the patient, carefully reviewing his history. The man reported having multiple tick bites over several years, but did not recall any type of skin rash. He also had paresthesia with tingling in his hands and feet 2 years earlier which lasted 4 months, writes Moreno Legast.

Further testing was initiated. A spinal tap was positive, showing an elevated protein level of 0.71 g/l and an increased CSF/serum antibody index for Lyme IgG of 27.5 but no pleocytosis. (Pleocytosis refers to an increased white blood cell count in cerebrospinal fluid.)

“According to the European Federation of Neurological Societies (EFNS) diagnostic criteria, our patient had a possible but not definite LNB [Lyme neuroborreliosis] because of absent CSF pleocytosis,” explains Moreno Legast.

Lyme disease triggers stroke in 83-year-old man, leaving him partially paralyzed in right arm. Click To Tweet

“Considering the possibility of a stage 3 LNB with cerebrovascular complications, antibiotic treatment with intravenous Ceftriaxone 2 g per day was administered for 14 days,” Moreno Legast states.

The antiphospholipid antibodies were negative at 6 weeks. “The patient slowly improved and was discharged a few weeks later,” according to Moreno Legast. He could walk with a cane but still had a severe right arm paresis.

“This case reminds us that, even after standard pharmacological treatment, LNB can lead to long-term sequels,” the authors write.

Moreno Legast and colleagues did not, however, address whether additional antibiotic therapy might have been helpful.

 

Related Articles:

Untreated Lyme disease triggers a stroke in 9-year-old boy

Stroke as a manifestation of Lyme disease

Cognitive issues following a stroke due to Lyme disease

Case report: Lyme neuroborreliosis more common in children 

 

References:

  1. Moreno Legast G, Schnider A, Nicastro N. Ischemic Stroke: Do Not Forget Lyme Neuroborreliosis. Case Rep Neurol Med. 2018;2018:1720725.

 


4 Replies to "Unexplained stroke: Look for Lyme disease"

  • Jo
    09/16/2020 (11:25 am)
    Reply

    I had just turned 40 and was having a hard year after losing someone close to me. I started to get I’ll. Headaches at first then migraine. Many time I found myself in hospital for a few days. No doctor had a clue but I got better and went home. At Christmas that same year I had a stroke. With much therapy I was able to go home. In the new year i still didn’t feel well but i thought i was depressed because of the stroke. Around April i went to see an eye doctor because I thought the stroke had weekend by sight. She sent me straight back to the doctor in the hospital the next day. He was able to reassure me that I was fine. This was confusing for me because I didn’t feel fine. 3 weeks later I went back to the same eye doctor who called an ambulance and had me taken to a specialist eye hospital. I then spent nearly 3 weeks in intensive care while I was tested for all number of things. My brain was swollen putting pressure on my eyes. Couldn’t move of the bed for weeks and for a few weeks after that I was in a wheelchair. Then they told me that they believed it to be limes disease. I am left feeling very week quickly and have trouble remembering stupid things and some rather important things but that was 7 years ago and I am still here.

    • Dr. Daniel Cameron
      09/16/2020 (7:02 pm)
      Reply

      How frustrating. I am glad you are still there.

  • Shereen
    08/03/2020 (9:40 pm)
    Reply

    I used to take out around 10-20 ticks off of my head, every “weekend” in Old Saybrook/Old Lyme, CT, when I was the age of 10-16. Although, I’ve been active (sports) all my life, I have also Been sick all my life and no professional one knew why. I suffer from headaches/migraines all my life and no professional one knew why. I was finally diagnosed with Chronic Lyme in 1996. Treated with plaquenil and doxycycline.
    As of 2016, I am on disability due to a stroke/endarterectomy, and no professional one knows why. What a life!,,

    • Dr. Daniel Cameron
      08/04/2020 (4:42 pm)
      Reply

      Have you looked a second time at whether retreatment or treatment of a co-infection might help?


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